tbuckley/cabot-search huggingface dataset:
AB1640 PREVALENCE AND ASSOCIATED FACTORS OF ATLANTOAXIAL SUBLUXATION IN PATIENTS WITH RHEUMATOID ARTHRITIS: A SINGLE-CENTER RETROSPECTIVE STUDY
Authors: Y. J. Song, S. Y. Kim, C. Lim, H. W. Kim, E. Nam, S. K. Cho, Y. K. Sung
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Atlantoaxial subluxation (AAS) is a serious complication of rheumatoid arthritis (RA) that can cause severe neck pain and neurological injury. <h3>Objectives</h3> This study aimed to identify prevalence and associated factors of AAS in Korean RA patients. <h3>Methods</h3> Data of RA patients who visited an academic referral hospital in Korea between September 2007 and August 2020 were extracted. Patients who were &lt;19 years old, had another autoimmune disease, or did not check cervical spine (C-spine) radiography were excluded. The date of the first C-spine radiography was set as the index date, and AAS was defined with anterior atlantoaxial interval (AADI) greater than 3mm. We performed multivariable logistic regression analysis to identify associated factors for AAS. The proportion of patients with AAS progression or those who received surgical treatment for AAS during observation period was investigated. <h3>Results</h3> There were 1,855 patients with diagnostic code of RA, and 1,115 patients with RA who checked C-spine radiography at least once were included. Among them, 156 patients had AAS at the index date with a prevalence of 14.0%, and the mean AADI in patients with AAS was 4.9±1.7 mm. In multivariable logistic regression analysis, longer duration of RA, lower body mass index (BMI), C-spine spondylosis, erosive changes on hand X-ray and higher C-reactive protein were significant associated factor for AAS. Among 156 patients with AAS, 106 patients performed C-spine radiography follow-up (mean interval 5.5±3.7 years). There were 16 patients (15.1%) with progression of AAS or surgical treatment: 12 patients who received surgery for AAS and four patients with AAS progression without surgical treatment. <h3>Conclusion</h3> In this study, 14.0% of patients with RA had AAS. Duration of RA, BMI, C-spine spondylosis, bone erosion at hands and RA activity were factors associated with AAS. 15.1% of RA-AAS patients showed progression of AAS or received surgical treatment during 5.5 years of observation. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Yeo-Jin Song: None declared, Sang Yoon Kim: None declared, Chaewhi Lim: None declared, Hye Won Kim: None declared, Eunwoo Nam: None declared, Soo-Kyung Cho: None declared, Yoon-Kyoung Sung Grant/research support from: YKS has received research grants from Bristol-Myers Squibb, Eisai, Pfizer, and JW Pharmaceutical.
AB1073 IS THERE A RELATIONSHIP BETWEEN BONE TURNOVER MARKERS AND DISEASE ACTIVITY IN TUNISIAN SPONDYLOARTHRITIS PATIENTS?
Authors: S. Rekik, S. Rahmouni, K. Zouaoui, S. Boussaid, H. Ajlani, H. Sahli, M. Elleuch
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> It has been reported that disease activity was correlated to the alterations in vitamin D metabolism and increased bone resorption in patients with spondyloarthritis (SpA). <h3>Objectives</h3> To investigate the relationship between bone turnover markers, Vitamin D levels and disease activity in SpA patients. <h3>Methods</h3> In this cross-sectional study, we included patients with SpA. In addition to the routine blood and urine tests, serum 25-(OH)D3, bone turnover markers (osteocalcin and Alkaline phosphatase (ALP) for formation, and serum C-terminal telopeptide (CTX) for resorption) of all participants were also measured. The disease activity was evaluated by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and AS disease activity scores (ASDAS-CRP) and the functional status by Bath Ankylosing Spondylitis Functional Index (BASFI). <h3>Results</h3> We included 79 patients (56 males, 23 females; mean age: 46.3 ± 1.9 years). The mean 25(OH)D, Calcium, Phosphor, ALP, PTH, Osteocalcin, CTX values were 17.7± 9.8 ng/ml, 89.70±12 (mg/l), 36.10 ±9.5 (mg/l), 84.6± 28.5(UI/l), 38.5 ±25.7 (pg/ml), 23.7± 9 (ng/ml), 0.57± 0.32(ng/ml), respectively. The mean BASDAI, ASDAS-CRP, BASFI, and CRP were 4.13±2.11, 3.21±1.19, 4.5±2.25 and 20.97±12,5 mg/l respectively. There were negative correlation between PTH levels and disease duration (p: 0.029, r: -0.248), ASDAS-CRP (p=0.017, p=-0,433) and CRP levels (p=0.014, r=-0.332). The present study didn't show any correlation between both APL, osteocalcin levels and BASDAI, BASFI, ASDAS-CRP (p&gt;0.05). We couldn't find any correlation between CTX and disease activity scores. <h3>Conclusion</h3> Bone formation markers (APL and osteocalcin) and bone resorption markers (CTX <b>I</b>) did not correlate with disease activity. However, PTH levels were negatively correlated with disease activity in patients with SpA. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0351 RELATIONSHIP BETWEEN NUTRITIONAL STATUS AND OSTEOPOROSIS IN ELDERLY PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: M. Ardhaoui, M. Ghali, J. Mahbouba, S. Zrour, I. Bejia, M. Touzi, N. Bergaoui
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Malnutrition is a recognised risk factor for osteoporosis. These two conditions are frequent comorbidities in rheumatoid arthritis (RA), especially in elderly patients. <h3>Objectives</h3> The aim of our study was to evaluate the association between malnutrition and osteoporosis among elderly patients followed for RA. <h3>Methods</h3> This is a cross-sectional study including patients followed for RA aged 65 years or older. Nutritional status was assessed by body mass index (BMI) and the Mini-Nutritional Assessment (MNA) questionnaire. Patients were divided into 2 groups according to the MNA: an "impaired nutritional status" group with an MNA score ≤ 23.5 and a "normal nutritional status" group with an MNA ≥ 24. Bone mineral density was assessed by two-photon X-ray absorptiometry. <h3>Results</h3> There were 63 patients (52 women and 11 men). The mean age was 68.17±4.35 years. The median duration of RA was 11 years with a IQR of [4-16]. The mean DAS28-VS was 3.72±1.48. The mean total MNA score was 20.19±4.71 [8-27.5]. According to the MNA, 76.2% of the patients had an «altered nutritional status» and 23.8% of the patients had a «normal nutritional status». The mean BMI was 27.97±5.44 kg/m². Osteoporosis was found in 25 patients (39.7%). In the «impaired nutritional status» group according to the MNA, there were significantly more osteoporotic patients (p=0.05). The mean T-score at the lumbar spine site was significantly lower in patients with MNA indicating «impaired nutritional status» (-2.36±1.17 SD vs -1.53±0.81; p=0.04), as was the mean T-score at the femoral site (-1.89±1.18 SD vs -1.03±0.76; p=0.001). A lower BMI was significantly associated with the T-score at the femoral site (p=0.04) but not at the lumbar spine site (p=0.18). <h3>Conclusion</h3> Our study showed that in elderly patients followed for RA, malnutrition diagnosed with the MNA score was significantly associated with osteoporosis and lumbar and femoral T-scores, and low BMI was associated with the femoral site T-score. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
Hedgehog signalling in allograft vasculopathy: a new therapeutic target?
Authors: Jasmine Rowell, Ching-In Lau, Diana C. Yánez, Eden Zhang, Tessa Crompton
Journal: Trends in Pharmacological Sciences (2023)

Allograft vasculopathy (AV) leads to chronic rejection of organ transplants, but its causes are obscure. New research from the Jane-Wit laboratory showed that Sonic Hedgehog (SHH) signalling from damaged graft endothelium drives vasculopathy by promoting proinflammatory cytokine production and NLRP3-inflammasome activation in alloreactive CD4+PTCH1hiPD-1hiT memory cells, offering new diagnostic and therapeutic strategies.
AB0540 COAGULATION AND HAEMOSTASIS PARAMETERS IN PREGNANT WOMEN WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND HEALTHY CONTROLS WITH AND WITHOUT PREECLAMPSIA
Authors: D. Lini, I. Gunnarsson, N. Mahmoud Hourani Soutari, S. Lalic-Cosic, A. MC Nicholas, R. Charieti, K. Bremme, F. Franceschini, E. Svenungsson, L. Andreoli, A. Antovic
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Women living with Systemic Lupus Erythematosus (SLE) are at increased risk of pregnancy complications, including preeclampsia (PE). Placental dysfunction is the key pathogenic event, but the underlying mechanisms are scarcely known. <h3>Objectives</h3> This study aimed to investigate global hemostatic assays in pregnant SLE patients in relation to PE and the use of anti-thrombotic prophylaxis. <h3>Methods</h3> Patients with SLE were sampled during the third trimester of gestation for coagulation and haemostasis (C&amp;H) assays: 1) overall coagulation potential (OCP); 2) overall haemostatic potential (OHP); 3) overall fibrinolysis potential (OFP), plasma levels of fibrinogen and D-dimer. Pregnant healthy controls (HC) with and without PE were also analysed. <h3>Results</h3> Twenty-two consecutive pregnant SLE patients, 80 pregnant HC without PE, and 42 pregnant HC with PE were analysed. Disease characteristics, pregnancy features, and coagulation parameters are reported in Table 1. No thrombotic or bleeding events occurred in SLE patients. Four SLE patients experienced PE (18.2%) despite treatment with low dose acetylsalicylic acid (LDASA) ± low molecular weight heparin (LMWH). These patients displayed significantly lower OCP and OFP, but not OHP, as compared to SLE without PE. Among 4 SLE+PE patients, the 2 treated with LMWH tended to have lower OCP, OHP, and OFP values as compared to the 2 untreated patients (134.9±190.7 vs 372.3±24.6; 90.6±128.2 vs 202.2±24.1; 16.4±23.3 vs 45.4±10.1). Among SLE patients treated with LMWH, undetectable OCP, OHP, and OFP were found in 1 out of 2 SLE+PE and 1 out of 6 SLE without PE. No differences across groups were found for fibrinogen and D-dimer levels. <h3>Conclusion</h3> C&amp;H parameters were altered in SLE pregnancy as compared to HC pregnancy, either in pregnancies complicated by PE or not. LWWH is expected to reduce to zero the values of OCP, OHP, and OFP, but this phenomenon was not observed in all SLE treated patients, suggesting that the response to LMWH can be variable among SLE pregnant patients. Larger and longitudinal studies across trimesters of gestation will clarify whether C&amp;H parameters are useful to monitor treatment effects and improve the management of SLE pregnancy. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB1208 THE RELATIONSHIP BETWEEN KNEE MUSCLE STRENGTH WITH DISABILITY AND PAIN IN PATIENTS WITH KELLGREN-LAWRENCE GRADE III-IV KNEE OSTEOARTHRITIS: A PILOT STUDY
Authors: I. Ayas, Z. Hazar, F. Abdulaliyev, C. Güngör, H. Ozer
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Knee osteoarthritis (OA) is the most common chronic joint disease and is the main cause of disability and pain. It is important to better understand potentially modifiable risk factors that may reduce disability and pain in advanced knee osteoarthritis. <h3>Objectives</h3> The aim of this study was to investigate the relationship between knee muscle strength with disability and pain in patients with advanced OA. <h3>Methods</h3> Twenty-one patients (66.05 ± 8.02 years, 32.77 ± 5.37 kg/m<sup>2</sup>) with Kellgren-Lawrence grade III-IV OA were included in this pilot study. Knee flexion and extension muscle strength were measured with Easy Force<sup>®</sup> isometric pull dynamometer in accordance with the make test procedure. Disability was measured with Knee Injury and Osteoarthritis Outcome Score (KOOS), and pain intensity was measured with VAS and Pain Catastrophizing Scale (PCS). <h3>Results</h3> The knee flexion strength of the patients was 75.52 ± 29.58 N, and the knee extension strength was 155.42 ± 49.84 N. Knee flexion strength was 17.85 ± 32.06 % and extension strength was 22.60 ± 21.10 % less than the other extremity. The total KOOS scores of the patients were 48.90 ± 24.78 %, PCS scores were 27.58 ± 15.82 and VAS were 8.42 ± 1.69. Flexion muscle strength of patients were moderately correlated with KOOS (r=0.44, p&lt;0.05), but not with PCS and VAS scores. Extension muscle strength of patients was highly correlated with KOOS (r=0.70, p&lt; 0.001), but not with PCS and VAS scores. <h3>Conclusion</h3> In advanced knee osteoarthritis, knee extension strength deteriorated more than knee flexion strength. Exercise interventions for knee extension strength training can provide superior outcomes in knee extensor strength and function but not in pain. <h3>References</h3> [1]Nishigami, T., Tanaka, S., Mibu, A. <i>et al.</i> Knee-related disability was largely influenced by cognitive factors and disturbed body perception in knee osteoarthritis. <i>Sci Rep</i><b>11</b>, 5835 (2021). [2]Pietrosimone B, Thomas AC, Saliba SA, Ingersoll CD. Association between quadriceps strength and self-reported physical activity in people with knee osteoarthritis. Int J Sports Phys Ther. 2014 May;9(3):320-8. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0843 THE EXPRESSION PROFILING OF CIRCULATING MIRNAS IN SYSTEMIC SCLEROSIS
Authors: S. Machhua, R. Minz, S. K. Sharma, Y. Kumar, S. Singh, S. Anand, S. Handa
Journal: Annals of the Rheumatic Diseases (2023)

Title: The expression profiling of circulating miRNAs in systemic sclerosis. <h3>Background</h3> Systemic sclerosis (SSc) is a rare chronic disease of unknown etiology. Genetics plays an important role in SSc's pathogenesis; however, considering genetic factors alone does not explain the disease's occurrence, epigenetic influences are also believed to contribute to SSc development [1]. miRNAs are reported to be aberrantly expressed in SSc patients and, therefore, potential contributors to its pathogenesis. The role of miRNAs in SSc is just beginning to unravel [2]. <h3>Objectives</h3> To investigate the expression profile of circulating miRNAs in SSc. <h3>Method</h3> Whole blood miRNA (84 miRNAs involved in human fibrosis) transcripts were identified by miScript miRNA PCR Array using RT-qPCR. <h3>Results</h3> Fourteen miRNAs (6 upregulated -hsa-miR-145-5p, hsa-miR-150-5p, hsa-miR-18a-5p, hsa-miR-195-5p, hsa-miR-223-3p, hsa-miR-29c-3p; 8 downregulated- hsa-miR-211-5p, hsa-miR-217, hsa-miR-31-5p, hsa-miR-328-3p, hsa-miR-335-5p, hsa-miR-382-5p, hsa-miR-449a, and hsa-miR-661) showed differential expression compared to controls. IPA (Ingenuity Pathway Analysis) predicted miRNA-mRNA targets gene (hsa-miR-145-5p, hsa-miR-18a-5p, and hsa-miR-449a- TGFβ1), were validated through qRT-PCR and found to be dysregulated in the SSc patients. DIANA-Mir Path v3.0 pathway analysis showed dysregulated miRNAs were associated with pathways implicated in SSc's pathogenesis (Figure 1). <h3>Conclusion</h3> The differentially expressed miRNA and their putative mRNA targets and associated pathways may provide diagnostic biomarkers as well as point to therapeutic targets for SSc treatments. <h3>References</h3> [1]Angiolilli C, Marut W, van der Kroef M, Chouri E, Reedquist KA, Radstake TRDJ. New insights into the genetics and epigenetics of systemic sclerosis. Nat Rev Rheumatol. 2018 Nov;14(11):657-673. [2]Tsou PS, Sawalha AH. Unfolding the pathogenesis of scleroderma through genomics and epigenomics. J Autoimmun. 2017 Sep;83:73-94. <h3>Acknowledgements</h3> Indian Council of Medical Research (ICMR) <h3>Disclosure of Interests</h3> None Declared.
AB0387 PREDICTIVE FACTORS OF DETECTION OF ULTRASOUND SYNOVITIS IN RHEUMATOID ARTHRITIS PATIENTS WITH CONCOMITANT FIBROMYALGIA
Authors: S. Miladi, B. A. Hiba, F. Alia, S. Ben Yaacoub, M. Yasmine, H. Bousaa, L. Souabni, K. Ouenniche, K. Selma, C. Selma, K. Ben Abdelghani, L. Ahmad
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Recent studies have shown that ultrasound (US) assessment of disease activity in rheumatoid arthritis (RA) with associated fibromyalgia (FM) before disease-modifying antirheumatic drug (DMARD) escalation is primordial. <h3>Objectives</h3> The purpose of this study was to identify predictive factors of detection of US synovitis and Doppler activity in RA patients with and without concomitant FM. <h3>Methods</h3> Cross-sectional study that included patients with diagnosis of RA (ACR/EULAR. 2010 criteria) with concomitant FM (ACR 2016) and to compare it to RA patients without FM. Demographic and RA characteristics were collected. US examination of 22 joints was blindly. performed by a single physician. US-detected synovitis was defined and scored 0-3 using. the OMERACT scoring system at the joint level for both grey-scale (GS) and Doppler power. (DP). The number of joints with ≥ grade 1 GS synovitis and those with ≥ grade 1 DP were. calculated. Multiple linear regression analysis performed, adjusting for clinical and. demographic variables. <h3>Results</h3> Eighty patients distributed into 40 patients in each group were recruited. Epidemiological and RA characteristics were comparable between groups. No significant. difference was observed between the groups in regards to mean DAS28 and the three- variables (DAS28 V3). Multiple linear regression showed that in RA-FM group US synovitis detection was positively. associated with male gender (B=0.135, p=0.045) and with DAS28 V3 (B=0.454,p=0.004), and negatively associated with the Patient global assessment (PGA) (B=-1.092,p=0.007). In. RA group (witout FM), US synovitis was positively associated with Swollen joints count. (SJC) (B=0.837, p=0.001). In RA-FM group, Doppler activity was positively associated with. the DAS28 V3 (B=0.637,p=0.04) and with Physician global assessment (B=0.873,p=0.023), negatively associated with the PGA (B=-0.642, p=0.005) while it was positively associated. with the DAS28 (β=3.08, p=0.047) in RA group. <h3>Conclusion</h3> Our study shows that a high DAS28 V3 seems to be significantly associated. with active synovitis in US assessment in RA patients with comorbid FM. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
AB0800 EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS CLINICAL MANIFESTATIONS AND OUTCOMES: A RETROSPECTIVE COHORT ANALYSIS OF 38 PATIENTS FROM RUSH UNIVERSITY MEDICAL CENTER CHICAGO, IL, USA
Authors: M. Orentas, Y. Zhang, J. Fair, A. Bukiej
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Eosinophilic granulomatosis with polyangiitis (EGPA) is the rarest anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis according to incidence and prevalence reports in the literature [1]. Typical manifestations include obstructive airway disease, nasal polyps, mononeuritis multiplex, eosinophilia, and eosinophilic-predominant inflammation on biopsy [2]. Studies have been published that describe the clinical manifestations and disease outcomes but these are limited [3]. Further studies are necessary to better understand this disease. <h3>Objectives</h3> This study characterized the clinical manifestations and outcomes of a cohort of Rush University Medical Center (RUMC) patients with EGPA. <h3>Methods</h3> Retrospective cohort analysis of EGPA patients at RUMC from 1/1/2010-12/31/2021. Clinical characteristics, treatment, and outcome were analyzed, using Fisher's Exact Test and Chi-Square Test to perform comparisons. <h3>Results</h3> This cohort included 38 patients with EGPA. 55% were female, 68% were Caucasian, and mean age at diagnosis was 57.7 (+/- 16.3). 95% had pulmonary involvement. 37% were (ANCA) positive. There was no statistically significant difference in clinical characteristics, treatment strategies, or outcomes when comparing ANCA positive to ANCA negative patients. <h3>Conclusion</h3> This analysis describes the clinical characteristics, treatment, and outcomes of a cohort of RUMC patients with EGPA. Prevalence of pulmonary involvement and ANCA positivity was similar to that reported in the literature. Unlike previous studies which reported higher prevalence of neurologic and kidney involvement in ANCA positive EGPA patients our study did not find a statistically significant difference in characteristics of ANCA positive patients when compared to ANCA negative patients. <h3>References</h3> [1]Romero-Gomez C, Aguilar-Garcia JA, Garcia-de-Lucas MD, et al. Epidemiological study of primary systemic vasculitides among adults in southern Spain and review of the main epidemiological studies. Clin Exp Rheumatology 2015; 33 Suppl 89: 11–8. [2]Grayson P, Ponte C, Suppiah R, et al. 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for eosinophilic granulomatosis with polyangiitis. Arthritis &amp; Rheumatology 2022; 3: 386-392. [3]Doubelt I, Cuthbertson D, Carette S, et al. Clinical manifestations and long-term outcomes of eosinophilic granulomatosis with polyangiitis in North America. ACR Open Rheumatology 2021; 3: 404–412. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.
POS0997-HPR LUPUS MORTALITY IN RELATION TO THE OVERALL ENVIRONMENTAL QUALITY INDEX AND ITS FIVE DOMAINS
Authors: R. Sharma, E. Yen, L. Chen, M. Sim, R. Singh
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Growing evidence suggests a role of exposure to chemicals and industrial pollutants, such as hydrocarbons, silica, mercury, organochlorines and trichloroethylene, particulate air pollution, UV radiation, infectious agents, living in certain geographic regions, and sociodemographic factors in increasing the risk and/or affecting the outcome of systemic lupus erythematosus (SLE). We utilized the environmental quality index (EQI) developed by the U.S. Environmental Protection Agency (EPA) to represent environmental quality to better understand the association between environmental factors and lupus deaths. Five domains including air, water, land, built and sociodemographic comprised the EQI. <h3>Objectives</h3> Here, we summarize the descriptive statistics between environmental exposures and lupus death and compared them to accidental deaths, heart disease and malignant neoplasm. <h3>Methods</h3> The study population comprises all individual U.S. deaths from 2006 to 2011. We describe mean/median EQI in lupus deaths versus those who died of other leading causes of death, namely accident, heart disease, and malignant neoplasm. Cause-specific death counts were obtained using ICD 10 codes: lupus (M321, M328, M329), accident (V, W, X0-5, Y85-86), heart disease (I0, I11, I13, I2-4, I50-51), and malignant neoplasm (C0-8, C90-97). <h3>Results</h3> There were 5,430 lupus deaths and 398,382 accidental deaths in the US from 2006 to 2011. The total EQI was significantly worse in lupus decedents than in accidental deaths (p&lt;0.001), but not when compared to deaths attributed to heart disease and malignant neoplasm. Of the five EQI domains, air and built, but not the other three domains, were higher in lupus decedents than in accident (p&lt;0.001), heart disease (p &lt;0.05), and malignant neoplasm (p&lt;0.05) decedents. <h3>Conclusion</h3> Total environmental quality as well as its air and built domains were worse in lupus decedents than in accidental deaths, suggesting a possible role of environmental exposure in contributing to lupus outcome. Further analysis is needed to identify the specific environmental determinants, which are potentially modifiable to improve lupus outcome. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.